plications, these data suggest they also have important longer-term implications that merit further investigation.The gold standard of safe-guarding the quality of published science is peer review. However, this long-standing system has not evolved in today's digital world, where there has been an explosion in the number of publications and surgical journals. https://www.selleckchem.com/products/jnj-42226314.html A journal's quality depends not only on the quality of papers submitted but is reflected upon the quality of its peer review process. Over the past decade journals are experiencing a rapidly escalating "peer review crisis" with editors struggling in recruiting reliable reviewers who will provide their skilled work for free with ever-diminishing incentives within today's restricted time-constraints. The problem is complex and difficult to solve, but more urgent than ever. Time is valuable and academicians, researchers and clinicians are overburdened and already extremely busy publishing their own research along with their ever growing clinical and administrative duties. Fewer and fewer individuals volunteer to provide their skilled work for free which is expected. The current incentives to review do not have a big impact on one's career and therefore are not realistic effective countermeasures. As the limits of the system are constantly stretched, there will inevitably come a "point of no return" and Surgical Journals will be the ones to first take the hit as there is an overwhelming evidence of burnout in the surgical specialties and the Surgical community is almost 50% smaller than its Medical counterpart. This review identifies the potential causes of the peer-review crisis, outlines the incentives and drawbacks of being a reviewer, summarizes the currently established common practices of rewarding reviewers and the existing and potential solutions to the problem. The magnitude of the problem and unsustainability that will make it perish are discussed along with its current flaws. Finally, recommendations are made to address many of the weaknesses of the system with the hope to revive it.We sought to construct a valid and reliable patient-reported outcome measure for patients with advanced malignancy and GIO.
Bowel obstruction is the most common indication for palliative surgical consultation in patients with advanced cancer; however, no validated patient-reported outcome measures exist for this population.
A total of 125 patients with GIO and 64 patients without GIO who underwent palliative surgical consultation completed the MDASI-GIO questionnaire and a single global quality-of-life question. Summary statistics were used to assess the symptom burden of GIO patients. Outcome measures were validity (construct and criterion) and reliability (internal and test-retest) for the MDASI-GIO.
The majority of patients rated the severity of each of the 5 following GIO-specific symptoms as moderate to severe (rating of ?5 on a 0 to 10 scale) "being unable to eat" (72%), "being unable to have a bowel movement" (65%), "abdominal discomfort" (62%), "stomach feeling full" (55%), and "abdominal cramping" (54%). The MDASI-GIO subscale Cronbach coefficient alpha values were 0.80-0.91, and intraclass correlations were 0.72-0.84. Correlations between MDASI-GIO subscales and global quality of life were -0.39 to -0.49 (P &lt; 0.001 for all comparisons). GIO patients had significantly worse symptoms and higher interference than did non-GIO patients (all P &lt; 0.05) with effect-size differences of ?0.36, supporting known-group validity.
The MDASI-GIO shows initial validity and reliability for assessing the severity of symptoms of patients with GIO and the interference of these symptoms in patients' daily functioning.
The MDASI-GIO shows initial validity and reliability for assessing the severity of symptoms of patients with GIO and the interference of these symptoms in patients' daily functioning.The aim of the present study was to critically reappraise the experience at our high-volume institution to obtain new insights for future directions.
The indications, surgical techniques, and perioperative management of pancreatoduodenectomy (PD) have profoundly evolved over the last 20?years.
All consecutive PDs performed during the last 20?years at the Verona Pancreas Institute were divided into four 5-year timeframes and retrospectively analyzed in terms of indications, intraoperative features and surgical outcomes. Significant milestones were provided to understand practice changes using a before-after analysis method.
The study population consisted of 3000 patients. The median age, ASA ? 3 and number of nonbenchmark cases significantly increased over time (p &lt; 0.005). Pancreatic cancer was the leading indication, representing 60% of patients/year in the last timeframe, 40% of whom received neoadjuvant treatment. Conversely, after the development of International Guidelines, the proportion of rly evolved in Verona over the past two decades. Surgeries of greater complexity are currently performed on increasingly frailer patients, mostly for pancreatic cancer and often after neoadjuvant chemotherapy. However, the progression of all fields of pancreatic surgery, including the expanding use of postoperative pancreatic fistula (POPF) mitigation strategies, has allowed satisfactory outcomes to be maintained.Controlling perioperative pain is essential to improving patient experience and satisfaction following surgery. Traditionally opioids have been frequently utilized for postoperative analgesia. Although they are effective at controlling pain, they are associated with adverse effects, including postoperative nausea, vomiting, ileus, and long-term opioid dependency.Following laparoscopic colectomy, the use of intravenous or intraperitoneal infusions of lidocaine (IVL, IPL) are promising emerging analgesic options. Although both techniques are promising, there have been no direct, prospective randomized comparisons in patients undergoing laparoscopic colon resection. The purpose of this study was to compare IPL with IVL.
Double-blinded, randomized controlled trial of patients undergoing laparoscopic colonic resection. The 2 groups received equal doses of either IPL or IVL which commenced intra-operatively with a bolus followed by a continuous infusion for 3?days postoperatively. Patients were cared for through a standardized enhanced recovery after surgery program.